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January 12, 2006

Inhaler ups survival in lung-transplant recipients

by Sam Savage

NEW YORK (Reuters Health) - Use of inhaled cyclosporine, in
addition to other immune-suppressing drugs in pill form, does
not help prevent the early rejection of lung transplants, but
it does seem to stave off long-term rejection and improve
survival, according to a report in The New England Journal of
Medicine.

Conventional immunosuppressive drugs do not prevent
long-term rejection after lung transplantation, lead author Dr.
Aldo T. Iacono, from the University of Maryland in Baltimore,
and colleagues note. Delivery of cyclosporine directly to the
lung transplant, through the use of an inhaler, may help cut
the rates of both early and long-term rejection.

To investigate, the researchers assessed the outcomes of 58
lung transplant recipients who were randomly assigned to use a
cyclosporine or inactive "placebo" inhaler for three days a
week for the first two years following transplantation.

As noted, no significant difference was seen between the
groups in the rate of early rejection. In each group, about
0.45 rejection episodes occurred per patient per year.

Fourteen patients in the placebo group died compared with
just three in the cyclosporine group, a reduction in risk of 80
percent. Long-term rejection-free survival was also better in
the cyclosporine group with 6 rejection events noted compared
with 19 in the placebo group.

The cyclosporine and placebo groups had similar rates of
kidney side effects and infections related to their suppressed
immune system, the report indicates.

"Further experience with inhaled cyclosporine is needed to
confirm the magnitude and durability of the observed effects in
recipients of single-lung and double-lung transplants," the
researchers add.

Dr. Malcolm M. DeCamp, from Beth Israel Deaconess Medical
Center in Boston, agrees that more studies are needed and notes
that research in this field is often lacking.

"These results should be received enthusiastically by
lung-transplant physicians and surgeons but need to be
confirmed in a more broadly inclusive multicenter trial. Such
trials have been woefully lacking in the lung-transplantation
world, in which 78 percent of centers perform fewer than 20
transplantations per year," he comments in a related editorial.